A 10-year, $12 million philanthropic initiative from the New Hampshire Charitable Foundation extends the prevention reach of New Hampshire’s Bureau of Drug and Alcohol Services.

About the Collaboration

In 2013, the New Hampshire Charitable Foundation—a private, philanthropic organization dedicated to addressing a variety of social causes—made a 10-year, $12 million commitment to work with the New Hampshire Department of Health and Human Services’ Bureau of Drug and Alcohol Services (BDAS) to reduce substance use among New Hampshire youth. The supplemental funding was earmarked for two purposes: to strengthen the state's newly expanded Regional Public Health Networks, and to support the design and delivery of critical prevention activities the state was unable to accomplish independently—either because of public funding restrictions or limited capacity.

"The state and philanthropy could more effectively address New Hampshire's substance misuse prevention working together," says Tym Rourke, the Foundation's Director of Substance Use Disorders Grantmaking and Strategic Initiatives. And so a unique prevention collaboration between the public sector and a private funder was born.

Working together, BDAS and the Foundation have focused their efforts on implementing the state’s comprehensive substance misuse strategy—Collective Action, Collective Impact—established by the Governor's Commission on Alcohol and Drug Abuse Prevention, Treatment and Recovery to "improve our collective action through expanded leadership, resourcing, best practices, training, monitoring, and other strategic activities."1

The Foundation also made direct grants to the Regional Public Health Networks to more readily support policy-related activities restricted under their federal grants. "Policy change is an important prevention strategy. As a Community Foundation, our funding is specifically allowed to support policy and advocacy work, which was a priority of the donor who established the fund," says Rourke. “This is a case where our resources were a perfect complement, given restrictions on use of public funds for certain types of policy work.”

The new partnership has the added benefit of keeping everyone focused and energized. "It's just part of the DNA of New Hampshire—that we are better together," Rourke says. "We can't have the impact alone that we can have together."

Elements of Success

Build on Each Other's Strengths

The collaboration is a win-win for both partners. The Foundation had a decades-long history of supporting social causes and a commitment to producing systems and population-level change. Additionally, the unique funds established by Foundation donors specific to substance use disorders efforts requires that funds expand and complement—rather than duplicate—existing state prevention services. The state had a newly reorganized regional prevention infrastructure capable of producing this level of change—but in need of additional support.

"It was important to find those places where we had unique value and bring those to the table—while staying focused on our common end goal," Rourke says. "There are unique elements of what we each do. We’ve taken advantage of these to improve our collective impact."

The Foundation provided critically needed funding to BDAS contracted providers at a time when the state had drastically cut funding for substance misuse prevention, treatment, and recovery due to the recession in 2008.2 The additional funding allowed the state to bolster existing work at the regional level to address underage drinking, and support new services to address the growing opioid epidemic. The flexibility of unrestricted private funds also allowed state contracted providers to engage in on-the-ground public education and policy support. For its part, the state brought experience and expertise in data collection, monitoring, and reporting.

Morgan adds that the Foundation's willingness to work with the state, and within the state's infrastructure, was key. "It wasn't like they wanted to go off on their own down some other avenue," she says. "Tym made sure that the Foundation built on the work we’d already begun."

Recognize Organizational Differences

From the start, the partners acknowledged differences in work style and culture, and worked to address them. For example, state offices operate according to federal and state funding cycles and requirements, which determine when grant monies are awarded and activities can begin. By comparison, the Foundation had more flexibility about when it awarded grants, and so could get work up and running faster.

The partners also worked hard to be transparent and accountable. This was not unfamiliar turf for either the state or the Foundation, but both had to deal with the other's process of reporting up through their chain of command. "There was some tension initially, as in any collaboration, regarding the different roles we play and the people we're accountable to," Morgan said. "I had on my state hat and Tym had on his Foundation hat."

Through regular meetings and direct conversations, both state and Foundation leaders came to understand and accommodate each other's work styles and organizational requirements. It helped that Rourke, who also chairs the Governor's Commission, has past experience running a Drug-Free Communities Coalition in the city of Manchester. "He knows what it's like to be a provider in the field," Morgan says. "We were able to hit the ground running because of Tym."

Rourke's insights into how both the public and private sectors operate helped smooth over rough patches on a very practical level. For example, to avoid creating extra paperwork for grantees, the Foundation awarded grant monies in sync with the state fiscal year—so grantees who were already providing information to the state could use that information to also meet the Foundation's grant requirements.

The state did its part by providing clear guidance on the differences between Foundation and state funds, and what each could and could not be used for. "We had to be crystal clear with our [providers] that yes, you've got two separate sources of funds here and there are different things that you can do with those funds," Morgan adds. "We had a learning curve for how we could use the Foundation money, including understanding the donor intent for the money."

Morgan created a "dog-and-pony show" presentation for the state’s 13 regional offices to "help them understand the deliverables [for the different funding mechanisms], as well as the difference between private funds and state and federal funds. We've become smoother at delivering our messaging."

Keep Meeting Participants Well Informed

Clear, consistent communication has been key to making the collaboration work at all levels. A core team of Foundation staff, Morgan, and Center for Excellence staff meets monthly to keep the collaboration on track. "The touch point every month is our State Prevention Team coming together," Morgan says. "This includes the people at the state levels doing the work and moving the ball down the court. We know where we all want to go, and [these regular meetings help us] all move in that direction."

Team leaders meet with coordinators and providers from the 13 regions every other month. Rourke says it's important to regularly bring regional prevention staff to the table, to support them in implementing the Governor’s Commission’s strategic plan and to address any issues that come up. The Foundation tries to make meetings more inviting, knowing prevention professionals have very busy schedules. "You can't get people to meetings without bagels, pizza, and water," Rourke says. The Foundation funds can be used to provide food and beverages for meetings which—as anyone who's attended long meetings knows—provide a welcomed and refreshing boost.

Morgan adds that good communication means not being afraid to pick up the phone and tackle problems head on, as they happen. Don't let potential problems fester or risk misunderstandings that can happen with a quickly dashed-off email. Her advice to other states seeking to collaborate with private funders is this: "Be transparent. When challenges come up, talk about them honestly and come together to overcome them. Tym and I have each other on speed dial, and if something comes up, we pick up the phone."

Impacts

Three years into their collaboration, the state is seeing positive results. "We have had significant declines in all rates of substance abuse since new [Foundation] funding was brought into the system," Rourke says. According to findings from the state’s 2015 Youth Risk Behavior Survey, between 2005 and 2015, past-30-day alcohol consumption among high school students grades 9 through 12 decreased from 44 to 30 percent, past-30-day marijuana use decreased from 26 to 22 percent, and past-30-day binge drinking decreased from 28 to 17 percent. In addition, from 2011 to 2015, high school students using prescription drugs without doctors' orders also decreased from 12 to 7 percent.3

"We've accomplished a lot," Morgan says. "This [collaboration] has aided us in not only building our capacity [to advance our prevention efforts], but in getting publicity about the need for substance use and misuse prevention in New Hampshire. Tym does a lot of public speaking and that has really helped us get the word out."

Each of the state’s regional networks developed its own 3-year strategic substance misuse prevention plan that aligns with the Governor's Commission’s Collective Impact strategic plan. Each region convenes and leverages local stakeholders that continue to advance and deepen the prevention system. "Our goal was to build a regional system so that every community in New Hampshire is touched by prevention," Rourke says. "Private dollars have helped give these networks sticking power in their communities. I think it's fair to say we have achieved our goal."

“New Hampshire used to have scattered prevention efforts happening in pockets across the state,” says BDAS Director Joseph Harding. “Now we have one that is highly aligned, that works as a system, and that is data driven. Our strong outcomes are a result of this systems approach, which addresses aligned goals and objectives.”

But there's still much more work to do. "We have an opioid crisis in New Hampshire as many states do, so we're coming together to address those issues and keep an eye on emerging trends," Morgan says.

Rourke, who belongs to a national network of behavioral health funders, says he is "encouraging other private funders to get engaged in supporting substance abuse prevention and partnering with their state colleagues"—something he says is critical during these turbulent and uncertain political times. "We will continue to not just fight for public financing, but to bring other donors and private funders into the mix."

Sources

1. New Hampshire Governor’s Commission on Alcohol and Drug Abuse Prevention, Intervention and Treatment. Collective Action – Collective Impact: New Hampshire's Strategy for Reducing the Misuse of Alcohol and Other Drugs and Promoting Recovery 2013–2017.